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Type of Visit: (DCompliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: E)"koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: .(X%' Departure Time:�3`County: Region:
Farm Name:///,,t�p,6yjg�� ®/'C�j✓r/„{� ,//GUn7� /
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: /11%4,u-rjTitle:
Onsite Representative: !�
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Integrator:
Phone:
Certification Number: / a2 -7:?
Certification Number:
Longitude:
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Wean to Feeder
Non La er
Calf
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Feeder to Finish
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HeiferFarrow
to Wean
Hill
ow,I
lNon-Dairy
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Farrow to Feeder+.�I�
Farrow to Finish
La erstocker Y{1{!
Gilts
Non -La ers
eeder
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Boars
Pullets
Beef Brood Cow
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Turkeys
Llei
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,= Turke Pouhs
Other
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Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes j]'No ❑ NA ❑ NE
Page I of 3 511212020 Continued
Facility Number: a - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes _i]"No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ErNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes L2,No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? 'Yes ❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes []--No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes -E� No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes Q�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes _E� No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind ❑ Application Outside of Approved Area
)Drift
l 12. Crop Type(s): �>iyc � .17/0,0 ce) `i!L ,:52
13. SoilType(s): �� �� �,ryt
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes -D No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes �No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes J2 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3-No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
13'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
- ff No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
,❑'No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. _,E]�Yes ❑ No ❑ NA ❑ NE
lYaste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E:l No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ErNo ❑ NA ❑ NE
Page 2 of 3 511212020 Continued
Facili Number: jDate of Inspection: p a-
24. Did the facility fail to calibrate waste application equipment as required by the permit? alYes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes Wo
the appropriate box(es) below. 1'
❑ Failure to complete annual sludge survey O'Failure to develop a POA for sludge levels
❑ NA ❑ NE
❑ NA ❑ NE
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: to 1 0 b 1 lt' 1 a j
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes E�No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes .e-No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[]Yes ,e'No ❑ NA ❑ NE
❑ Yes J:�No ❑ NA ❑ NE
❑ Yes J No ❑ NA ❑ NE
[—]Yes .❑ No ❑ NA ❑ NE
❑ Yes .4❑ o
[—]Yes Q'No
,❑-lYes ❑ No
J� -S S&'
Z) AAd. 'Ve,e Pew
Oaf '-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Phone: 15;�(J 93_5�_ 7ci�s
Date: A�a��a�
511212020
FACILITY#: 0 %}_ FARM NAME: LAGOON //G/.�{i� LAGOON LEVEL
PERMIT If 11.'
- DUE EVERY 5 YEARS
- EXPERIATION DATE
- CURRENT NUMBER OF ANIMAL
- OIC CARD YES OR NO
NUMBER OF ANIMALS
WASTE UTILIZATION PLAN (WUP) (#20)
SOILTYPES v
CROP TYPES
ODOR CONTROL CHECK LIST YES OR NO
Irrigation Plan Maps YES OR NO
WASTE REPORT (#21)
-GOOD FOR 60 DAYS BEFORE OR AFTER
DATE ��/NITROGEN LEVEL/®
DATE Ca- '2'3 NITROGEN LEVEL � -y
DATE L .� NITROGEN LEVEL �i2I
lol)Ylr� l,lS
SOIL REPORT (1)
- EVERY 3 YEARS: DATE ✓L/oZGI / r�- L
- P-1 (NO MORE THEN 400)
- PH (N.I, lV4.,I..)
- Cu2N (NO MORE THEN 3000) CU ZN
(IF PEANUTS NO MORE THEN 300)
Not over PAN CROP TYPES
FLOW RA
Not over PAN CROP TYPES
FLOW
Not over PAN CROP TYPES
I RR2 (u i)
NITROGEN (N)
NITROGEN (N)
FLOW RATES NITROGEN (N)
Not over PAN CROP TYPES
FLOW RATES NITROGEN (N)
CALBRIATION (#241
EACH REEL SHOULD BE CALIBRATED EVERY OTHER YEAR
DATE OF CALIBRATION - n
FLOW RATES
-INITIAL AFTER I" RAIN EVENT I/ RAIN FALL
-LOOK FOR ANY LEVEL THAT IS LESS THEN THE DESIGNED FREEBORED POA NEEDED.
Yo
/
-DUE EVERY YEAR: DATE �"�,,1LUDGE(#r&2s)
0: �-L, 1.0 P: a 1 % RATIO OF SLUDGE
0: P: % RATIO OF SLUDGE
O: P: % RATIO OF SLUDGE
0: P: % RATIO OF SLUDGE
OTHER FORMS (#22 AND #21)
ib
RAIN BREAKER FORM CROP YEILDS _ MORTALITYI_
*If fields are grazed there will be no crop yields
VISUAL CHECK
FOUNDATION OR PIT LEAKS _ PIPE LEAKS_ LAGOON SEEPAGE LAGOON BARE
AREAS TREES OR GRASS NEED TO BE REMOVED EROSION DITCHES
WINTER CROP(OVERSEEDED) HARVESTED FIELDS_ GOOD HEALTHY CORPS_ CORRECT
CROPS NO PONDING REELS FEED BINS LAGOON GARBAGE
Bermuda grass: Opens March 1�t- Ends September 30th
Small Grain Over seed: Opens October 1-t- Ends March 31A
Corn: Opens February 15t -Ends June 30t
Cotton: Opens March 15t - Ends August 1A
Rye: Opens September 1A-Ends March 31A
Oats: Opens September IA- Ends April i Sw
Wheat Opens September 1st- Ends April 30th
Soybeans: Opens April 1-t-Ends September 15t
Fescue: Opens August 1st- Ends July 31A
Sorghum Hay: Opens March 15w - Ends August 31 st